RAND researchers describe promising practices identified by staff from nine health centers in California that were participating in the Sustainable Models of Telehealth in the Safety Net initiative. These practices show the potential to support the growth and sustainability of telemedicine programs in safety-net settings. However, there is not yet sufficient evidence to prove that such practices will be effective across settings.

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Promising Practices for Telemedicine Implementation

by Alina I. Palimaru, Jessica L. Sousa, Allison J. Ober, Lori Uscher-Pines

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Research Questions

  1. What types of practices were perceived to be promising?
  2. What goals were each practice supposed to accomplish?
  3. What was the context in which each practice seemed to be most suitable?

As part of the Sustainable Models of Telehealth in the Safety Net initiative process evaluation, staff from health centers in California described numerous promising practices that facilitated telemedicine implementation. In the context of the initiative, a promising practice was defined as a practice that shows potential to support the growth and sustainability of telemedicine programs in safety-net settings. Promising practices are associated with successful outcomes in certain circumstances. However, there is not yet sufficient evidence to prove that they will be effective across settings. The practices discussed in this report fall into the following categories: practices to reduce or manage no-shows, practices to facilitate communication between primary care providers and specialists, practices for negotiating favorable contracts with telemedicine providers, practices to reduce obligations for on-site staff, practices to improve patient buy-in for telemedicine, practices to improve provider buy-in for telemedicine, practices to improve sustainability, and miscellaneous practices.

Key Findings

Reducing no-show rates was a priority for many telemedicine coordinators

  • All participating health centers described efforts to offer transportation support between patients' homes and the health center, attempted to schedule other patient encounters on the day of the telemedicine visit to increase efficiency and save patients multiple trips, and reminded patients about upcoming appointments and asked them to confirm their attendance.

Communication problems between providers resulted in poor coordination of services

  • Some health centers assigned telemedicine coordinators or medical assistants to monitor the return of laboratory tests, notify primary care providers (PCPs) about results, and notify patients about next steps.
  • Other health centers encouraged direct communication between PCPs and telemedicine providers by giving telemedicine providers access to the health center's electronic medical record system and ensuring that contracts with telemedicine vendors included language requiring opportunities for clarification about diagnoses, treatment plans, and follow-up questions.

Health centers found it difficult to negotiate contracts with telemedicine providers

  • Although most health centers paid telemedicine providers for blocks of time regardless of the number of visits that occurred, three health centers negotiated contracts in which the telemedicine provider was paid for completed visits. This model was considered to be more sustainable for health centers because they were not penalized for no-shows and telemedicine providers had greater incentive to be productive.

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This research was funded by the California Health Care Foundation and conducted by the Access and Delivery Program within RAND Health Care.

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